[MCOH-EH] MRO question

[Hudson, T. Warner]

Quest HPP comprehensive 1

Sent from my BlackBerry 10 smartphone.
From: Borkowski, Michael
Sent: Friday, November 14, 2014 7:58 PM
To: 'MCOH/EH'
Reply To: MCOH/EH
Subject: Re: [MCOH-EH] MRO question


Dr. Hudson

Please provide additional information:  type of drug test, method and quantitative results, if applicable.

Thanks


Michael Borkowski, MD, MPH
Medical Director, F&MCW Occupational Health Services
Phone:  414-805-7997  | Fax:  414-805-7995
Cell Phone:  414-881-3762
E-mail: michael.borkowski at froedtert.com

Froedtert & the Medical College of Wisconsin
Occupational Health Services
9200 West Wisconsin Avenue
Milwaukee, WI 53226
froedtert.com

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Hudson, T. Warner
Sent: Friday, November 14, 2014 5:02 PM
To: Karl Auerbach; MCOH/EH
Subject: Re: [MCOH-EH] MRO question

I have a suspicion based result back on a nurse; has Rx for Dilaudid and Hydrocodone/acetaminophen:
Positive for:
Morphine
Codeine
Hydrocodone
Hydromorphone

My sources say the latter two make sense (hydromorphone and hydrocodone) but not the morphine and codeine.  Any debate one that?

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health
UCLA Health System and Campus
Office 310.825.9146
Fax 310.206.4585
Pager 800.233.7231  ID 27132
E-mail twhudson at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces+twhudson=mednet.ucla.edu at mylist.net] On Behalf Of Karl Auerbach via MCOH-EH
Sent: Friday, October 10, 2014 1:03 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] MRO question

It is a bit suspicious but don’t forget that drug tests are done at levels which may be well below the therapeutic “half life” calculations.

I would be happy to send this on to the MRO list where you might get much more input.

Karl

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Holt, Claudine
Sent: Friday, October 10, 2014 1:29 PM
To: 'mcoh-eh at mylist.net'
Subject: [MCOH-EH] MRO question

 Dear Colleagues,

I have an MRO question and would appreciate some feedback:

Someone came in for a pre-placement physical (in a patient care role) and the drug screen came back positive for phenobarbital.  She denies use of any barbiturate and none of the medications that she is on should cause a positive barbiturate screen.  However, she called me back a day later to say that she had a colonoscopy on 9/9 and her gastroenterologist told her that might have caused the positive test.  The drug test was done 20 days after the colonoscopy on 9/29 and as far as I know, you don’t typically get a barbiturate during a colonoscopy.

I asked her to have the anesthesiologist’s report sent to me so I could see what was administered.

The t ½ of phenobarbital is 53-140 hours (per Up to Date).  Since it takes about 5 half-lives to eliminate something, it  could take from 265-700 hours.  She had the procedure on 9/9 and the drug test on 9/29 which is  480 hours.  So if she was given phenobarbital during the procedure, it actually might have been in her system.

Has anyone ever dealt with anything like this?  What are your thoughts?


Sincerely,

Claudine Holt, MD, MPH
Staff Physician, Occupational Health Services
Temple University Hospital
Basement, Rock Pavilion
215-707-8151 (phone)
215-707-5751 (fax)



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